Transplant RENAL ARTERY stenosis (TRAS) is a relatively frequent, potentially curable cause of refractory hypertension and allograft dysfunction and usually becomes apparent between 3 months and 2 years after RENAL transplantation. Depending on the hemodynamic significance of stenosis it can be treated conservatively or by revascularization. Here we describe a case of TRAS which was treated successfully with angioplasty and stenting and then we will have a review on its etiology, natural history, diagnosis and therapy.

Background: TRANSPLANTED RENAL ARTERY stenosis (TRAS) is a well-known potentially curable cause of post-transplantation arterial hypertension, allograft dysfunction, and graft loss. Percutaneous transluminal angioplasty and stenting are relatively less invasive approaches for the treatment of post-transplantation TRAS.Methods: From March 2014 to March 2015, 154 patients underwent kidney transplantation (113 deceased and 41 live donors).4 patients (2 men and 2 women) who had advanced diabetes, vascular access problem, re-transplantation and obesity, developed RENAL and iliac ARTERY stenosis and stent placement was performed. In these patients, blood pressure, body weight, urine output and Doppler ultrasound parameters were regularly evaluated pre-operatively and daily for one month after angioplasty. Angioplasty was conducted for 2 patients on the second post-operative day; the other 2 patients underwent the procedure 10 days after their transplantations.Results: The mean age of the 4 patients (2 deceased and 2 live donors) was 42 (range: 13–63) years. Serum creatinine decreased after angioplasty in 3 patients below 1.8 mg/dL at discharge. One patient needed dialysis after angioplasty (the serum creatinine decreased to 1.2 mg/dL after three weeks). No patient returned for dialysis after the discharge.Conclusion: Percutaneous transluminal angioplasty and stenting are safe and effective procedures to relieve RENAL ARTERY and/or iliac stenosis. High risk patients with complications such as advanced diabetes, difficult vascular access and re-transplantation should undergo the procedure in high-tech centers equipped with Cath. Lab. and well-experienced endovascular interventionists to prevent graft loss.

Introduction: RENAL transplantation has established itself as the treatment of choice for the majority of patients with End stage RENAL failure (ESRF). Arterial stenosis is the most common vascular complication after kidney transplantation, occurring in approximately 4%-25% of transplant recipients.Case Report: The patient is a 68 year old man with ESRF due to Poly cystic kidney disease (PCKD) that was treated by RENAL transplantation from a living donor. Vascular anastomosis was end to end from RENAL ARTERY to right internal iliac ARTERY. After 1.5 month from transplantation, serum creatinine (Cr) raised to 3.1. In color duplex ultrasound Resistance index (RI) in intra RENAL arteries and spectral wave form in intratenal, RENAL and internal iliac arteries indicated severe stenosis in internal iliac ARTERY proximal to anastomosis. Magnetic resonance angiography (MRA) shows stenosis of about 80%-90% in internal iliac ARTERY proximal to anastomosis. Radionuclide scan with TC-DTPA suggests mild hydronephrosis & RENAL dysfunction, so for this patient PTA was performed. 24 hours after stent placement, serum Cr decreased to 2.1. In color Doppler ultrasound, 48 hours after stent placement, wavefrom, time and resistance indices are in normal range.Radionuclide scans 3 days after angioplasty demonstrated normal RENAL function. Important notes about this case were, short time (1.5 month) from transplant to presentation of symptoms of arterial stenosis, arterial stenosis proximal to anastomosis in internal iliac ARTERY, and stenosis following transplantation from a living donor.Conclusion: Because of successful PTA in this case, stent placement is suggested as an effective and useful treatment for arterial stenosis after RENAL transplantation.

Immunosuppressive drugs are prescribed routinely to kidney transplant recipients to prevent rejection. These medications are associated with an increased risk of secondary malignancies, including RENAL cell carcinoma in the TRANSPLANTED kidney itself. We present a case of RENAL cell carcinoma in a TRANSPLANTED kidney.

Introduction: Many studies showed that simultaneous pancrease and kidney transplantation will improve diabetic neuropathy. We designed a study for clarifying effects of kidney transplantation alone on neuropathy of type 1 diabetic patients.Methods: From April 2007 to June 2010, thirty RENAL TRANSPLANTED patients with type 1 diabetes mellitus and thirty type 1 diabetic patients with ESRD were enrolled in this study. Electroneurodiagnostic tests of peroneal, sural, ulnar, and median nerves were done. Nerve Conduction Velocity (NCV), Compound Motor Action Potentials (CMAPs) and Sensory Nerve Action Potentials (SNAPs) were analyzed at 6, 12, and 18 months after RENAL transplantation (RT).Results: The NCV improved in the RT group in 18 months of follow up period versus baseline (P<.01). This parameter worsened significantly in the control group throughout the study (P=.03) and in a cross sectional analysis between two groups, we could not find any remarkable differences (P=.07). Both SNAP and CMAP amplitudes improved in the RT (SNAPSural, P=.04, SNAPMedian, P=.01, CAMPPeroneal, P=.03, and CAMPUlnar, P=.02) but they worsened in the control group (SNAPSural, P<.001, SAPMedian, P<.01, CAMPPeroneal, P<.01, and CAMPUlnar, P<.01). Comparison of both groups did not show any significant statistical changes.Conclusions.Electroneurodiagnostic values improved after RENAL transplantation in type 1 diabetic patient with ESRD but cross sectional analysis did not revealed statistical differences between studied groups.

True aneurysms of the RENAL arteries are a very rare entity. Herein we describe a case of saccular left RENAL ARTERY aneurysm found as an incidental angiographic finding in an adult, hypertensive female. She also had an accessory RENAL ARTERY supplying the lower third of the left kidney. She underwent surgery, during which the large RENAL ARTERY aneurysm was resected and the RENAL blood flow restored with aortoRENAL bypass graft with autologous saphenous vein. Postoperative recovery was uneventful, and her blood pressure is presently well-controlled.

RENAL ARTERY stenosis now is one of the well recognized causes of Ischemic nephropathy and arterial Hypertension. It is one of the most challenging fields in medicine. Like other vascular anomalies, RENAL ARTERY stenosis does not always have clinical outcomes. RENAL ARTERY stenosis can be seen with accompanying of other vascular abnormalities like arterial duplication, but stenosis of all supplying arteries together is rare.Case Reportation: Patient is a 65 years old man, known case of poor control hypertension, chronic RENAL insufficiency and CVA, presented with diarrhea, repeated vomiting and deterioration of RENAL function. After clinical evaluation, patient underwent RENAL angiography and with bilateral duplication and RENAL arteries stenosis in all four arteries, and then angioplasty was per formed. RENAL function returned to normal and blood pressure controlled.

Soft tissue calcification is common in uremic patients. Wound calcification or ossification is not so prevalent except in specific conditions like inflammation and ischemia or wound tension. We present a 40-year-old TRANSPLANTED patient, not only periRENAL ossification but also with multiple periRENAL stones. The presentation was severe pain on the site of transplantation. Pre-op CT scan revealed periRENAL calcified mass. Intraoperative finding was very thick tissue accompanied with a lot of stones around the TRANSPLANTED kidney. The patient had history of ureteral fistula after RENAL transplantation that needed temporary percutaneous nephrostomy and then uretero-neocystomy. It seems that urinary leakage through nephrostomy site probably is the predisposing factor for stone formation around the kidney where as there is no stone inside the Kidney.

Background and Objectives: In patients with chronic RENAL failure , delayed visual evoked potential (VEP) in addition to peripheral neuropathy is reported. In this study delayed visual evoked potential (VEP) was tested in chronic RENAL failure (CRF) patients on hemodialysis and those with RENAL transplantion.Materials and Methods: A total of thiry three patients in two groups were selected for VEP test. Group I consisted of 17 patients with CRF on hemodialysis (aged 19-60 years) and Group II included 16 TRANSPLANTED patients (aged 19-57 years). We studied pattern shift VEP (PSVEP) with 34 checks after ruling out diabetes and ophthalmologic examination. P100 wave latency and amplitude were compared between two groups with students t-Test. Results: VEP abnormality was seen in 35% of hemodialysed patients, while such abnormality was not observed in 16 TRANSPLANTED patients. Mean P100 wave latency with 34 checks in group I was 110±9.95ms and in group II it was 103±5.28 ms and this difference was significant (p<0.05). P100 wave amplitude in group I was 6.9µv and in group II it was 9.4µv, however this difference was not significant (p>0.05). There was no significant relationship between VEP and hypertension, creatinine, PTH, duration of hemodialysis and transplantation (p>0.05).Conclusions: Delayed neural conduction in visual pathway is seen in patients with chronic RENAL failure, that can be improved after successful RENAL transplantation. Etiologic factors associated with abnormality might be circulating toxins or demyelination.

Background and Objective: Atherosclerosis is the most important cause of death in hemodialysis and RENAL TRANSPLANTED patients while hyperlipidemia and lipid peroxidation are considered major risk factors of it. For this reason, the most important goals of therapy are elimination of risk factors of atherosclerosis among these patients. Since peroxidation of lipids are a multifactorial process and all factors have not been investigated in one study, we decided to investigate, serum concentrations of total cholesterol, triglycerides, cholesterol contained of high density lipoprotein (HDL-c), concentration of albumin, total magnesium (Mg), malondialdehyde (MDA) and total antioxidant of these patients and compare the results with corresponding data obtained for age and sex matched control group. Materials and Methods: In this cross-sectional study, 30 patients who were on hemodialysis and 30 RENAL TRANSPLANTED patients were participated. Parameters mentioned above were measured using sera separated from the fasting blood collected from the patients. Evaluation of these parameters were done by following protocols provided by the manufactures of the kits, The results obtained were compared with the corresponding data of 30 healthy persons who served as control group. In addition, the cholesterol contained of low density lipoprotein (LDL-c) was calculated and plasma level of cyclosporine was measured for RENAL TRANSPLANTED patients.Results: Evaluated data showed elevation in the serum levels of triglycerides (p<0.05), MDA (p<0.001) and decrease in the serum levels of total antioxidant among hemodialysis and RENAL TRANSPLANTED patients (p<0.001). In addition, the serum levels of magnesium in hemodialysis patients were higher than control group (p<0.01), while it was lower in RENAL transplant patients (p<0.01). Finally, Serum albumin levels were significantly lower in the patient groups, when compared with control group (p<0.01). Pearson regression analysis showed a positive and significant correlation between triglycerides level and MDA (r= -0.47, p<0.001) and negative correlation with total antioxidant (r=-0.42, p<0.01). In addition, there was a negative and significant correlation between Mg and cyclosporine level (r=-0.44, p<0.01) among RENAL TRANSPLANTED patients.Conclusion: In conclusion, present results demonstrated that cyclosporine is the most important cause of hypomagnesaemia in RENAL TRANSPLANTED patients. Therefore, oral magnesium supplement should be used for these patients, when cyclosporine recommended. In addition, low levels of antioxidant detected among the patient groups suggest that prescription of oral antioxidant such as vitamin C and E could reduce the risk of atherosclerosis in these patients.